Provider Demographics
NPI:1144375064
Name:LEE, KWANG K (CHIROPRACTOR)
Entity type:Individual
Prefix:MR
First Name:KWANG
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23830 HWY 99 101
Mailing Address - Street 2:LIFE CHIROPRACTIC CLINIC
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-778-9191
Mailing Address - Fax:425-673-5122
Practice Address - Street 1:23830 HWY 99 101
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-778-9191
Practice Address - Fax:425-673-5122
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62071Medicare UPIN
AB13347Medicare ID - Type Unspecified